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Analysis of validity in adults of the expanded protocol of orofacial myofunctional evaluation with scores
Abstracts / Sleep Medicine 14S (2013) e93–e164
Conclusion: Discussion. This research is the first to demonstrate the effectiveness of an intervention program for the improvement of health behaviors including sleep patterns, controlled use of electronic media and the improvement in quality of life of young adolescents, with parents as the sole agents of change. On the theoretical level the research supports and enhances the Conceptual Model and demonstrates that the model may be used in other health areas in adolescents apart from eating habits. This research adds to the body of the literature about the relationships between sleep patterns, exposure to electronic media and quality of life in young Israeli adolescents. Regarding the practical application, the findings show that programs tailored for parents can make changes in health related behaviors in young adolescents. Acknowledgements: Based on the research limitations it is suggested that future research should be longer and accompany the parents also during the stage of long-term maintenance of the new behaviors. It is also recommended that future interventions should include the motivational component, which deals with elements related to the motivation for behavioral change, both within the parent and within the adolescent. http://dx.doi.org/10.1016/j.sleep.2013.11.283
Analysis of validity in adults of the expanded protocol of orofacial myofunctional evaluation with scores G. Aparecida Folha, F. Cardoso Pereira Valera, C. Giovana Borges, F. Claudia Maria De Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
Introduction: Patients with various acquired diseases (e.g. cerebrovascular accident, traumatic brain injury), degenerative diseases (e.g. Parkinson’s disease, multiple sclerosis), obstructive sleep apnea (OSA), among others, may benefit from therapy protocols with orofacial exercise. But, an important role for this therapy process as documentation of the orofacial myofunctional characteristics is necessary. The Orofacial Myofunctional Evaluation Protocol with Scores (OMES) is an instrument validated to assess orofacial myofunctional status on children and adults. So far, the expanded version (OMES-E) in terms of numerical scales and items was validated for children only. The aims of this study were to analyze the validity, the reliability of the OMES-E protocol in adults. Materials and methods: Participants were 50 subjects (21 to 59 years old, mean 41.44 ± 11.38), without distinction of race and gender. The exclusion criteria were neurological or cognitive deficit, tumors or traumas in the head and neck, and use of medication. One speech therapist performed the examination . To analyze criterion validity, the subjects were evaluated individually with the OMES-E protocol, according to the previously described methodology. After, based on video-recorded images, the subjects were revaluated using the OMES as reference protocol. The correlation between the protocols was calculated. The test of the reliability of interpretation of the OMES-E was performed with revaluation of 20% of the sample. To analyze the construct validity, we calculated the sensitivity (S), specificity (E), accuracy (A) and predictive values (VP+ e VP ). For these, the cutoff point proposed for OMES and OMES-S, the 75th, was adopted. Thus, subjects who presented an OMES score lower than 80 and an OMES-E score lower than 152 were considered to have relevant OMD. Descriptive statistical analysis for the OMES-E protocol was performed. Spearman correlation and coefficient Kappa weighted (Kw) was performed using the MedCalc software. Significance level was 0.05. Results: There was statistical correlation between the OMES and OMES-E protocols (r = 0.87). Inter-examiner (E1 E2) agreement and reliability with the OMES-E protocol was 0.74 and r = 0.75
e127
respectively. For the OMES-E protocol mean values of 0.90 for A, 0.67 for S, 0.91 for E, 0.77 for VP+ and 0.86 for VP were found. Conclusion: Thus, the OMES-E protocol is valid and reliable for adult orofacial myofunctional evaluation, with good S, E and A, as well as predictive values. Acknowledgements: This work received support from CAPES, the Brazilian Federal Agency for Support and Evaluation of Postgraduate Education. http://dx.doi.org/10.1016/j.sleep.2013.11.284
Assessment of surface EMG supra-hyoid muscle activity in apneic patients compared to healthy subjects. A pilot study G. Folha, A. Mapelli, F. Cardoso Pereira Valera, L. Dantas Giglio, L. Vitaliano Voi Trawizki, C. Maria De Felício Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
Introduction: Snoring and obstructive sleep apnea (OSA) are associated with swallowing disorders, probably due to tissue trauma of the pharynx caused by snoring. Spontaneous swallowing (SS) is a frequent physiologic act, characterized by a complex and coordinated activation of many stomatognathic, pharyngeal, and laryngeal muscles. Surface electromyographic (sEMG) activation of the submandibular muscles is strictly connected to the swallowing biomechanical events. The strongest relationship is between the elevation and the anterior displacement of the hyoid bone and the sEMG signal of the supra-hyoid muscles. Objective. To assess the characteristics of supra-hyoid muscle activity during SS condition in patients with moderate-severe OSA and healthy subjects. Materials and methods: Eleven patients with untreated moderate– severe OSA diagnosed by polysomnography (GOSA) and 11 subjects without OSA signs or symptoms (GC) were analyzed. Simultaneous bilateral sEMG activity from supra-hyoid muscle were evaluated during SS of saliva. Each sEMG signal was filtered and rectified. The onset of swallowing was detected when the signal rose clearly above the preceding background activity. The end was scored when the signal returned to levels of background activity. Right and left signals were averaged. The temporal difference between the beginning and end of the swallowing act determined the deglutition time. For amplitude evaluations, a standardization of the signal was applied considering the maximum peak of saliva swallowing amplitude as 100%. The amplitude value was extracted for the initial and final events of each standardized signal. For the maximum peak, the time delay from the beginning was also detected. The t-test was calculated for each parameters, with significance level at 5%. Results: There was no difference regarding the age between groups (p = 0.23), instead BMI were different (p < 0.01). For the SS of saliva the GOSA showed greater mean values of initial (24% vs 15%, p < 0.01) and final (22% vs 16%, p = 0.02) standardized amplitude. Swallowing time duration was smaller, even if not statistically significant, in GOSA (0.855 vs 1.103 s, p = 0.08) with an anticipated maximum peak delay (0.357 vs 0.569 s, p = 0.05). Conclusion: SS in moderate–severe OSA patients was characterized by both intensity and temporal differences in supra-hyoid muscle activity with respect to healthy subjects. Further investigations are being performed to deepen the characterization of different OSA degree of severity. Acknowledgements: This work was supported in part by University of São Paulo – Protocol No. 11.1.21626.01.7 and the first author received a fellowship from Coordination of Improvement of Higher Education Personnel (CAPES), Brazil. http://dx.doi.org/10.1016/j.sleep.2013.11.285
Conclusion: Discussion. This research is the first to demonstrate the effectiveness of an intervention program for the improvement of health behaviors including sleep patterns, controlled use of electronic media and the improvement in quality of life of young adolescents, with parents as the sole agents of change. On the theoretical level the research supports and enhances the Conceptual Model and demonstrates that the model may be used in other health areas in adolescents apart from eating habits. This research adds to the body of the literature about the relationships between sleep patterns, exposure to electronic media and quality of life in young Israeli adolescents. Regarding the practical application, the findings show that programs tailored for parents can make changes in health related behaviors in young adolescents. Acknowledgements: Based on the research limitations it is suggested that future research should be longer and accompany the parents also during the stage of long-term maintenance of the new behaviors. It is also recommended that future interventions should include the motivational component, which deals with elements related to the motivation for behavioral change, both within the parent and within the adolescent. http://dx.doi.org/10.1016/j.sleep.2013.11.283
Analysis of validity in adults of the expanded protocol of orofacial myofunctional evaluation with scores G. Aparecida Folha, F. Cardoso Pereira Valera, C. Giovana Borges, F. Claudia Maria De Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
Introduction: Patients with various acquired diseases (e.g. cerebrovascular accident, traumatic brain injury), degenerative diseases (e.g. Parkinson’s disease, multiple sclerosis), obstructive sleep apnea (OSA), among others, may benefit from therapy protocols with orofacial exercise. But, an important role for this therapy process as documentation of the orofacial myofunctional characteristics is necessary. The Orofacial Myofunctional Evaluation Protocol with Scores (OMES) is an instrument validated to assess orofacial myofunctional status on children and adults. So far, the expanded version (OMES-E) in terms of numerical scales and items was validated for children only. The aims of this study were to analyze the validity, the reliability of the OMES-E protocol in adults. Materials and methods: Participants were 50 subjects (21 to 59 years old, mean 41.44 ± 11.38), without distinction of race and gender. The exclusion criteria were neurological or cognitive deficit, tumors or traumas in the head and neck, and use of medication. One speech therapist performed the examination . To analyze criterion validity, the subjects were evaluated individually with the OMES-E protocol, according to the previously described methodology. After, based on video-recorded images, the subjects were revaluated using the OMES as reference protocol. The correlation between the protocols was calculated. The test of the reliability of interpretation of the OMES-E was performed with revaluation of 20% of the sample. To analyze the construct validity, we calculated the sensitivity (S), specificity (E), accuracy (A) and predictive values (VP+ e VP ). For these, the cutoff point proposed for OMES and OMES-S, the 75th, was adopted. Thus, subjects who presented an OMES score lower than 80 and an OMES-E score lower than 152 were considered to have relevant OMD. Descriptive statistical analysis for the OMES-E protocol was performed. Spearman correlation and coefficient Kappa weighted (Kw) was performed using the MedCalc software. Significance level was 0.05. Results: There was statistical correlation between the OMES and OMES-E protocols (r = 0.87). Inter-examiner (E1 E2) agreement and reliability with the OMES-E protocol was 0.74 and r = 0.75
e127
respectively. For the OMES-E protocol mean values of 0.90 for A, 0.67 for S, 0.91 for E, 0.77 for VP+ and 0.86 for VP were found. Conclusion: Thus, the OMES-E protocol is valid and reliable for adult orofacial myofunctional evaluation, with good S, E and A, as well as predictive values. Acknowledgements: This work received support from CAPES, the Brazilian Federal Agency for Support and Evaluation of Postgraduate Education. http://dx.doi.org/10.1016/j.sleep.2013.11.284
Assessment of surface EMG supra-hyoid muscle activity in apneic patients compared to healthy subjects. A pilot study G. Folha, A. Mapelli, F. Cardoso Pereira Valera, L. Dantas Giglio, L. Vitaliano Voi Trawizki, C. Maria De Felício Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
Introduction: Snoring and obstructive sleep apnea (OSA) are associated with swallowing disorders, probably due to tissue trauma of the pharynx caused by snoring. Spontaneous swallowing (SS) is a frequent physiologic act, characterized by a complex and coordinated activation of many stomatognathic, pharyngeal, and laryngeal muscles. Surface electromyographic (sEMG) activation of the submandibular muscles is strictly connected to the swallowing biomechanical events. The strongest relationship is between the elevation and the anterior displacement of the hyoid bone and the sEMG signal of the supra-hyoid muscles. Objective. To assess the characteristics of supra-hyoid muscle activity during SS condition in patients with moderate-severe OSA and healthy subjects. Materials and methods: Eleven patients with untreated moderate– severe OSA diagnosed by polysomnography (GOSA) and 11 subjects without OSA signs or symptoms (GC) were analyzed. Simultaneous bilateral sEMG activity from supra-hyoid muscle were evaluated during SS of saliva. Each sEMG signal was filtered and rectified. The onset of swallowing was detected when the signal rose clearly above the preceding background activity. The end was scored when the signal returned to levels of background activity. Right and left signals were averaged. The temporal difference between the beginning and end of the swallowing act determined the deglutition time. For amplitude evaluations, a standardization of the signal was applied considering the maximum peak of saliva swallowing amplitude as 100%. The amplitude value was extracted for the initial and final events of each standardized signal. For the maximum peak, the time delay from the beginning was also detected. The t-test was calculated for each parameters, with significance level at 5%. Results: There was no difference regarding the age between groups (p = 0.23), instead BMI were different (p < 0.01). For the SS of saliva the GOSA showed greater mean values of initial (24% vs 15%, p < 0.01) and final (22% vs 16%, p = 0.02) standardized amplitude. Swallowing time duration was smaller, even if not statistically significant, in GOSA (0.855 vs 1.103 s, p = 0.08) with an anticipated maximum peak delay (0.357 vs 0.569 s, p = 0.05). Conclusion: SS in moderate–severe OSA patients was characterized by both intensity and temporal differences in supra-hyoid muscle activity with respect to healthy subjects. Further investigations are being performed to deepen the characterization of different OSA degree of severity. Acknowledgements: This work was supported in part by University of São Paulo – Protocol No. 11.1.21626.01.7 and the first author received a fellowship from Coordination of Improvement of Higher Education Personnel (CAPES), Brazil. http://dx.doi.org/10.1016/j.sleep.2013.11.285